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Our integration is much better. We have cell modems on our LP15s, so it's just a matter of hitting the 'send' button, using the scroll wheel to pick the hospital, and click to send...

> In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always < 10 minutes from the hospital, its not the most productive use of time.

Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPAA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPAA effectively.

I interviewed for Physio, but turned down their offer due to mandatory drug testing. They seemed to be really, really locked down due to regulations, and I suppose I do want the regulations on defibrillators to be fairly strict.

Physio absolutely has an automated version of that, it just requires integration on the part of the hospital (and an upgrade to the LifePak to add a cell modem).

The entire process: - Hit the send button - Click the wheel to pick the destination - Spin the wheel to highlight the destination hospital - Click the wheel to select - Spin the wheel to 'Transmit' - Click the wheel to send it

Done...

Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPPA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPPA effectively.

There are several companies (including a couple YC alums like Aptible) working in the helping-developers-deal-with-HIPPA space already. Creating a compliant application for transmitting ECGs wouldn't really be a new thing-- when attending an emergency medicine conference two years ago I met a physician/programmer who had done just this for both stroke and heart attack, designed and marketed as a wraparound subscription-based solution. The trick is doing it well, and if you could integrate the information with the receiving hospital's workflows (e.g. EPIC integration or something) you could sell it easier. Pictures of ECGs are also a fairly inelegant solution compared to sending it to the ECG printers that a receiving hospital has, or sending the actual waveform data, but for rural/underfunded EMS agencies it would be nice.

(FWIW, I work in a Bay Area emergency department that is a STEMI receiving center but does not receive field-transmitted ECGs prior to arrival. There's room to work on this stuff. If anyone wants to do research relating to it or build a system and then let me do research with it, get in touch.)

Are there procedural hurdles for the reasonably local hospitals to automatically get copies of any emergency EKG being done in the region?

There would clearly be some concerns with making sure that the right data was matched up with the right patient, I'm just wondering about how the technology could work, and what the more subtle issues might be.

I'm not sure how to approach the topic, but there is competition between hospitals. They are ultimately forced to be businesses and have bottom lines.

Why would you want to send it anywhere other than the hospital you're heading to?

It isn't clear to me that the destination is always strictly determined; in the article, the ER doctor or consulting cardiologist would sometimes divert the ambulance. So the simplest implementation has the copy being easily available at the 'reasonably local' hospitals, rather than having someone push a button to send it to the diversion destination.

edit: I see in your other comment that you are talking about scrolling to the correct hospital. It seems less good for the immediately involved technician to spend time on this than for whoever it is at the hospital to do it (I did already mention the caveat about record matching).

It adds, _maybe_ three seconds to the process of transmitting an EKG. The interface is pretty well designed. It makes more sense for me to be the person making that decision as I am the person with the most complete clinical picture at the time that decision is made.

If I'm sending an EKG, I'm also going to be picking up the phone shortly to talk things over with the doc at that ER. There would never be a situation where I don't already know where I'm going before transmitting an EKG.

My question could be rephrased as: Why is it a decision?.

When you pick up the phone and are talking to someone, the system could be showing them the EKG you did, with no intervention on either end.

I realize there is much opportunity there for bad implementation, I'm more interested in understanding the characteristics of a great implementation. Maybe there are reasons to leave it to the discretion of the EMT, but it being easy for the EMT to handle isn't one that I find very satisfying (I find it arbitrary to the implementation).

It's a decision because different hospitals have different specialities. Trauma, stroke, cardiac, etc. The most appropriate facility is a combination of what the patient needs, what they want, and the logistics involved (travel time, relative busyness, etc).

I call the hospital because I want to make sure they got the transmission and are going to be ready for me when I get there. The transmission and the call are generally a couple minutes apart.

There are certainly _plenty_ of places where the workflow in the back of the rig could be improved, but this really isn't one of them.

Have to say, this seems like an area where I'd be very happy there's an experienced human weighing all the various factors and making the judgement call.

After reading the procedure you've described I feel very grateful for our highly developed acute care system, and the dedicated pros who make it all work.

I get that it isn't a big time taker, so this is just abstract commentary.

This is an obvious opportunity for improvement: I call the hospital because I want to make sure they got the transmission. The ideal case would be that you don't even have to think about whether they have the information or not, the system should handle that with very high reliability.

You've also taken "decision" differently than I meant it. I meant, why do you have to decide to transmit the EKG, not the decision about which hospital to go to. Repeating myself, it would seem to be an improvement if you didn't have to pay any attention to whether the appropriate hospital had access to any readings/recordings that you had (I would think it would be better if it were trivial for someone there to pull them up, of course with high reliability).

I'm not feeling around for some opportunity to innovate/improve, I'm just curious about the factors that such a system has to deal with, and which of those factors are less idea than they could be, and why. That it isn't a big opportunity for improvement is useful feedback in general, but it doesn't really address the curiosity.

When I say I'm confirming they got it, I mean I'm confirming someone actually looked at it. The fact that it was delivered successfully is indeed reported to me.

The act of transmitting the EKG serves to give the hospital a heads up that I'm coming, and that I think this patient needs care right away. I understand you're suggesting a system where every bit of data my monitor collects is available in every hospital in real-time, so I just have to call them up and reference it. My point is that is that the act of sending the EKG is a really miniscule part of the process. You're talking about 5 seconds over the course of a 30 minute event.

I don't think the tradeoffs in complexity and quiet failure modes would be worth it. If I transmit something, I get a confirmation right then that it did or didn't work. If a passive data aggregation system fails (and I'm used to it 'just working'), then I may not notice that it failed.